Thyroid Cancer

Abstract

ImportanceApproximately 43 720 new cases of thyroid carcinoma are expected to be diagnosed in 2023 in the US. Five-year relative survival is approximately 98.5%. This review summarizes current evidence regarding pathophysiology, diagnosis, and management of early-stage and advanced thyroid cancer.ObservationsPapillary thyroid cancer accounts for approximately 84% of all thyroid cancers. Papillary, follicular (≈4%), and oncocytic (≈2%) forms arise from thyroid follicular cells and are termed well-differentiated thyroid cancer. Aggressive forms of follicular cell-derived thyroid cancer are poorly differentiated thyroid cancer (≈5%) and anaplastic thyroid cancer (≈1%). Medullary thyroid cancer (≈4%) arises from parafollicular C cells. Most cases of well-differentiated thyroid cancer are asymptomatic and detected during physical examination or incidentally found on diagnostic imaging studies. For microcarcinomas (≤1 cm), observation without surgical resection can be considered. For tumors larger than 1 cm with or without lymph node metastases, surgery with or without radioactive iodine is curative in most cases. Surgical resection is the preferred approach for patients with recurrent locoregional disease. For metastatic disease, surgical resection or stereotactic body irradiation is favored over systemic therapy (eg, lenvatinib, dabrafenib). Antiangiogenic multikinase inhibitors (eg, sorafenib, lenvatinib, cabozantinib) are approved for thyroid cancer that does not respond to radioactive iodine, with response rates 12% to 65%. Targeted therapies such as dabrafenib and selpercatinib are directed to genetic mutations (BRAF, RET, NTRK, MEK) that give rise to thyroid cancer and are used in patients with advanced thyroid carcinoma.ConclusionsApproximately 44 000 new cases of thyroid cancer are diagnosed each year in the US, with a 5-year relative survival of 98.5%. Surgery is curative in most cases of well-differentiated thyroid cancer. Radioactive iodine treatment after surgery improves overall survival in patients at high risk of recurrence. Antiangiogenic multikinase inhibitors and targeted therapies to genetic mutations that give rise to thyroid cancer are increasingly used in the treatment of metastatic disease.

Papillary Thyroid Cancer Remodels the Genetic Information Processing Pathways

“…The thyroid surgical approach is frequently combined with 131I radiotherapy (recommended in 2015 by the American Thyroid Association [31]) or with the administration of antiangiogenic multikinase inhibitors (e.g., lenvatinib, sorafenib, and cabozantinib) for cancers resistant to radioactive iodine [32]. Novel specific kinase inhibitors (SKI) like trametinib are also considered efficient for thyroid cancer treatment [33].…”

Advances in targeted therapy and biomarker research in thyroid cancer

“…Women are more likely than men to develop thyroid cancer, and the risk increases with age ( 3 ). Some regions with high iodine intake might have a higher prevalence of subtypes of thyroid cancer ( 4 ). Possible symptoms include a lump or swelling in the neck, swallowing difficulty, chronic neck pain, and hoarseness ( 4 ).…”

“…Some regions with high iodine intake might have a higher prevalence of subtypes of thyroid cancer ( 4 ). Possible symptoms include a lump or swelling in the neck, swallowing difficulty, chronic neck pain, and hoarseness ( 4 ). The diagnosis procedure involves a physical examination, imaging tests including ultrasonography, and a biopsy to confirm the existence of cancerous cells ( 4 ).…”

“…Possible symptoms include a lump or swelling in the neck, swallowing difficulty, chronic neck pain, and hoarseness ( 4 ). The diagnosis procedure involves a physical examination, imaging tests including ultrasonography, and a biopsy to confirm the existence of cancerous cells ( 4 ). The potential treatment options are determined by the type and stage of thyroid cancer.…”

Deep convolutional neural network model ResNeSt for discrimination of papillary thyroid carcinomas and benign nodules in thyroid nodules diagnosed as atypia of undetermined significance

“…The most prevalent cancer in the endocrine system is thyroid cancer ( 1 ), among which papillary thyroid carcinoma (PTC) remains the most common type, accounting for 84% of all malignancies ( 2 ). The main clinical challenge is to rule out malignancy as most thyroid nodules are asymptomatic, benign, and do not require surgical treatment.…”